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CASE WESTERN RESERVE UNIVERSITY

EXIT INTERVIEW SURVEY DATE

Name Department Position

Date

Supervisor Hire Date of Separation

The information obtained from exit interviews is used as a management tool in determining areas of potential concern. All responses areconfidential and will not become part of the employee's personnel file unless otherwise stated.

Request that comments remain anonymous Yes No

REASONS FOR LEAVING REASON FOR ACCEPTING JOB AT CWRUFrom the list below, circle your most From the list below, circle your most importantimportant reason for leaving. reason for accepting employment.

01. PAY 14. PAY

02. WORKING CONDITIONS 15. WORKING CONDITIONS

03. BENEFITS 16. BENEFITS

04. LOCATION 17. LOCATION

05. AMOUNT OF WORK REQUIRED 18. PURSUE EDUCATION/TUITION WAIVER

06. DISSATISFIED WITH SUPERVISOR/POLITICS 19. ADVANCEMENT

07. TO BE AT HOME 20. GOOD OPPORTUNITY08. PURSUE EDUCATION 21. OTHER (specify)

09. ILLNESS

10. TRANSPORTATION

11. ADVANCEMENT

12. RETIREMENT

13. OTHER (SPECIFY)

Please express your feelings about each of the following aspects of your employment. Rate each item 1, 2, or 3, 1 being belowexpectations, 2 met expectations, and 3 exceeded expectations. If you rate any of the items below expectations, please explain in thecomment section below.

YOUR JOB Below Met Exceeded (expectations)

22. Opportunity to use your abilities and skills 1 2 3

23. Training you received 1 2 3

24. Interesting/challenging work 1 2 3

25. Amount of work required 1 2 3

26. Recognition for a job well done 1 2 3

27. Cooperation within your department 1 2 3

28. Cooperation with other departments 1 2 3

29. Your sense of accomplishment 1 2 3

Comments:

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YOUR WORK AREA/OFFICE Below Met Exceeded (expectations)

30. Facilities 1 2 3

31. Office/lab/shop equipment 1 2 3

32. Parking 1 2 3

33. University Circle safety 1 2 3

Comments:

YOUR SUPERVISOR AND CO-WORKERS34. Overall working relationship with your supervisor 1 2 3

35. Overall working relationship with your co-workers 1 2 3

36. Your supervisor's managerial skills 1 2 3

37. Your supervisor's technical skills 1 2 3

38. Co-worker's technical skills 1 2 3

Comments:

COMMUNICATION, POLICIES AND PRACTICES39. Promotion policies and practices (job posting) 1 2 3

40. The opportunity to talk with your supervisor 1 2 3

41. Opportunity to make suggestions 1 2 3

42. Opportunity to register complaints 1 2 3

Comments:

COMPENSATION AND BENEFITS43. Starting salary 1 2 3

44. Ending salary 1 2 3

45. Annual review(s) of your performance 1 2 3

46. Annual review(s) of your salary 1 2 3

Comments:

47. Please write in here which medical provider you had

48. Medical Insurance 1 2 3

49. Dentemax 1 2 3

50. Retirement Plan 1 2 3

51. Life Insurance 1 2 3

52. Long Term Insurance 1 2 3

53. Tuition Waiver 1 2 3

Comments:

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SUMMARY

54. If the department seeks a replacement for you, in your opinion what kind of qualifications, skills and interest should that individual

possess?

55. What type of employee programs should the Human Resources Department initiate?

56. Would you consider working for CWRU again? ___ Yes ___No

If no please explain:

57. Would you recommend CWRU as an employer to others? Why or why not?

58. Do you have any suggestions for making CWRU a better place to work?

59. Additional comments:

If you are moving, please provide your forwarding address and phone number. If a forwarding address is not available, list thename and phone number of a contact.

Name

Street Phone Number

City, State, Zip Code

Relative or Contact Relationship Phone Number

HR30110101